Zonegran
zonisamide
Pharmacologic class: Sulfonamide
Therapeutic class: Anticonvulsant
Pregnancy risk category C
Action
Raises seizure threshold and reduces seizure duration, probably by stabilizing neuronal membranes through action on sodium and calcium channels
Availability
Capsules: 25 mg, 50 mg, 100 mg
Indications and dosages
➣ Adjunctive treatment of partial seizures
Adults and children older than age 16: Initially, 100 mg P.O. daily for 2 weeks, then, if required, increased to 200 mg P.O. daily for at least 2 weeks. May increase in 100-mg increments at 2-week intervals to 300 to 400 mg daily as required. Daily dosage ranges from 100 to 600 mg.
Dosage adjustment
• Hepatic or renal impairment
• Elderly patients
Off-label uses
• Infantile spasms
• Progressive myoclonic epilepsy
• Weight loss
Contraindications
• Hypersensitivity to drug or other sulfonamides
Precautions
Use cautiously in:
• hepatic or renal disease
• pregnant or breastfeeding patients
• children younger than age 16 (safety not established).
Administration
• Give with or without food.
Adverse reactions
CNS: drowsiness, fatigue, agitation, irritability, depression, dizziness, psychomotor slowing, psychosis, asthenia, abnormal gait, incoordination, tremor, ataxia, headache, confusion, impaired memory, hyperesthesia, paresthesia, seizures
EENT: diplopia, amblyopia, nystagmus, tinnitus, rhinitis, pharyngitis
GI: nausea, vomiting, diarrhea, dyspepsia, dry mouth, anorexia, pancreatitis
GU: renal calculi
Hematologic: anemia, leukopenia
Respiratory: cough
Skin: rash, pruritus, bruising, Stevens-Johnson syndrome
Other: abnormal taste, weight loss, allergic reactions, oligohidrosis and hyperthermia (in children), flulike symptoms, accidental injury
Interactions
Drug-drug. Carbamazepine, phenobarbital, phenytoin, valproic acid: decreased zonisamide blood level and effects
CYP450-3A4 inducers: decreased zonisamide half-life
CYP450-3A4 inhibitors: increased zonisamide blood level
Drug-diagnostic tests. Blood urea nitrogen, creatine kinase, creatinine: increased levels
Platelets, white blood cells: decreased counts
Patient monitoring
• Monitor CBC with white cell differential.
• Assess neurologic status; report significant adverse reactions.
• Monitor renal function tests. Watch for signs and symptoms of renal calculi.
See Monitor for rash, which may be first sign of Stevens-Johnson syndrome. If rash occurs, discontinue drug and notify prescriber immediately.
Patient teaching
• Explain therapy to patient. Instruct him to keep seizure diary and show it to prescriber.
• Instruct patient to swallow capsules whole. Advise him to drink 6 to 8 glasses of water daily to help prevent kidney stones.
See Warn patient that stopping drug abruptly may cause status epilepticus.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects him and until seizures are well controlled.
See Tell patient to immediately report rash, fever, sore throat, sudden back pain, depression, speech or language problems, or painful urination.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
zonisamide
(zoe-niss-a-mide) zonisamide,Zonegran
(trade name)Classification
Therapeutic: anticonvulsantsPharmacologic: sulfonamides
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (blood levels†)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | unknown | 2–6 hr | 24 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- suicidal thoughts (life-threatening)
- drowsiness (most frequent)
- fatigue (most frequent)
- agitation/irritability
- depression
- dizziness
- psychomotor slowing
- psychosis
- weakness
Ear, Eye, Nose, Throat
- amblyopia
- tinnitus
Respiratory
- cough
- pharyngitis
Gastrointestinal
- anorexia
- nausea
- vomiting
Fluid and Electrolyte
- metabolic acidosis
Genitourinary
- kidney stones
Dermatologic
- stevens-johnson syndrome (life-threatening)
- oligohydrosis (↑ in children)
- rash
Metabolic
- hyperthermia (↑ in children)
Neurologic
- abnormal gait
- hyperasthesia
- incoordination
- tremor
Interactions
Drug-Drug interaction
Drugs that induce or inhibit CYP3A4 may alter blood levels and effects of zonisamide.Blood levels and effects may be ↓ by phenytoin, carbamazepine, phenobarbital, or valproate.May enhance the adverse/toxic effect of carbonic anhydrase inhibitors, avoid combination.Route/Dosage
Availability (generic available)
Nursing implications
Nursing assessment
- Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.
- Monitor frequency, duration, and characteristics of seizures.
- Monitor patient frequently for development of skin rash. Unexplained rash may require discontinuation of therapy.
- Assess patient for allergy to sulfa drugs.
- Lab Test Considerations: Monitor renal function periodically during therapy. May cause ↑ creatinine and BUN.
- Measure serum bicarbonate before starting and periodically during therapy. Metabolic acidosis may be more frequent and severe in younger patients.
- May cause ↑ in serum alkaline phosphatase.
Potential Nursing Diagnoses
Risk for injury (Adverse Reactions)Implementation
- Oral: May be administered with or without meals. Capsules should be swallowed whole.
Patient/Family Teaching
- Instruct patient to take zonisamide as directed, even if feeling well. Consult health care professional if a dose is missed. Do not discontinue abruptly without consulting health care professional; may cause seizures. Instruct patient to read the Medication Guide before starting and with each Rx refill, changes may occur.
- Instruct patient to contact health care professional immediately if skin rash occurs or seizures worsen. Patient should also contact health care professional if a child taking zonisamide is not sweating as usual, with or without a fever, or if they develop fever, sore throat, oral ulcers, easy bruising, depression, unusual thoughts, speech or language problems.
- May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until cleared by health care professional and effects of medication is known.
- Advise patient to increase fluid intake to at least 6–8 glasses of water/day to minimize risk of kidney stones. Instruct patient to contact health care professional if symptoms of kidney stones (sudden back pain, abdominal pain, blood in urine) occur.
- Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
- May have teratogenic effects. Advise women of childbearing age to use effective contraception throughout therapy. Instruct patient to notify health care professional if pregnancy is planned or suspected or if planning to breast feed.
Evaluation/Desired Outcomes
- Decrease in frequency and duration of partial seizures.